oncology/gi/meds Flashcards
damage to the DNA of your cell
cancer
top cancers for women
breast
colon
lung
liver
top cancer for men
prostate
lung
liver
colon
controls growth cells
proto-oncogene
- mutated proto-oncogene
- uncontrolled cell growth
oncogene
slows down cellular division, cause cell death
tumor suppressor gene
uncontrolled cell growth
mutated tumor suppressor gene
resemble normal cell
less aggressive
typically benign
well differentiated
function more like normal cell
grow slower rate
well differentiated
do not resemble normal cell
aggressive
typically malignant
poorly differentiated
immature cells
lack structure/function
poorly differentiated
tumor cells grow only locally and cannot spread by unvasioin or metastasis
benign (non cancer)
cells invade neighboring tissue, enter blood vessels, and metastasize to different sites
malignant (cancer)
well differentiated cells
benign
usually localized effects
benign
(destruction) usually none unless flow impaired
benign
morbillity- minimal unless location interferes with vital function
benign
poorly differentiated cells
malignant
generalized: anemia, weakness, wt loss
malignant
often extensive; excretes toxins, uses up blood supply
malignant
high- unless growth and spread can be controlled/halted
malignant
“fingers” of cancer cells invade surrounding tissuw
locally invasive
malignant cells travel through blood or lymph system & invade other tissues or organs to form secondary tumor
metastasis
what are the common sites of metastases
lung
brain
liver
bone
what are the risk factors for cancer?
tobacco and smoking
diet and obesity
sedentary lifestyle
occupational exposure
family history
viruses
peritnatal factors/growth
alcohol
socioeconomic status
pollution
UV radiation
drugs and medical procedures
salt, food additives and contaminants
what is the hallmark of hereditary cancer syndrome?
-cancer in 2 or more relatives
-cancer in family member <50 years old
-same type of cancer in multiple family members
-rare type of cancer in 1 or more family members
- family members with more than 1 type of cancer
causes inflammation that can cause mutation
suppress the immune system
viruses
what are some virus examples that can turn into cancers?
HPV
Hepatitis B/Hepatitis C
Epstein-Barr
Human Herpes Virus 8
HIV
Helicobacter pylori
HPV
cervical cancer
Hepatitis B/Hepatitis C
liver cancer
Epstein Barr
Lymphoma
HIV
Lymphoma
Kaposi’s sarcoma
Helicobacter pylori
stomach ulcers
lymphoma in the stomach lining
-health promotions and illness prevention
-reduction of cancer mortality via reduction in the incidence of cancer
-lifestyle change, diet, adequate nutrients, avoiding alcohol, stress reduction
primary prevention
-screening (self breast and testicular exams)
-halt the progress of cancer through early screening and diagnosis
-targets to a specific cancer (pap smear, mammogram, colonoscopy, etc..)
secondary prevention
- disease treatment and rehabilitation
-health restoration
-prevent further deterioration
(chemotherapy, radiation, surgery,
-disease treatment
tertiary prevention
look for cancer before symptoms appear
- goal: find cancer in the early stages
screening
what are the types of screening?
-physical exam
-lab tests
-imaging procedures
-genetic testing
what age are the colorectal screening guidelines
beginning at 45 for both males and females
when should the fecal occult blood (FOBT)type be taken?
yearly
when should the flexible sigmoidoscopy be taken?
every 5 years
when should colonoscopy be given?
every 10 years
is colon cancer slow growing or fast growing?
slow growing
when should you start doing SBEs?
age 20+
at what age should breast exams be done by the HCP every 3 years?
age 40-44
at what age should HCP do breast exam and mammo yearly?
age 45-54
at what age should you go to see the HCP for a breast exam every 2 years?
age 55
when should pts go to the HCP if they are at high risk for cancer?
pts should go to the HCP to do MRI and mammogram yearly
what is the cervical screening?
pap smear
women should go to HCP within 3 years of initiating intercourse
what are the 7 warning signs of cancer?
-change in bowel or bladder habit
-a sore that does not heal
-unusual bleeding or discharge
-thickening or lump in breast or else where
-indigestion or difficult swallowing
-obvious change in a wart or mole
-nagging cough or hoarseness
pathologist compares the appearance of cancer cells to the normal surrounding cells
grading
classifying a malignancy by the extent of spread within the body
staging
who does the grading/differentiate?
pathologist
who does the staging?
oncologist
GX
can not be assessed
G1
(low grade):well differentiated, slow growing
G2
(moderate grade): moderately differentiated, growing slightly faster
G3
(high grade): poorly differentiated, growing faster
G4
(high grade):undifferentiated, not distinct at all, very aggressive
Stage 1
small cancer found only in organ where it originated
stage 2
larger cancer that may/may not have spread to the lymph nodes
stage 3
larger cancer also in the lymph nodes
stage4
cancer has spread from original site into other organs
what is the tnm system?
it is the staging process
what does t stand for?
t-size of primary tumor
what does the n stand for?
n- number of lymph nodes involved
what does the m stand for?
m- extent of metastasis
Tx
tumor size can’t be measured
T0
no primary tumor, or can’t be found
Tis
tumor is “in situ”
T1
small or early stage
T2
confined to original area
T3
has spread to surrounding tissues
T4
large, advanced stage cancer
what are the worse tumor sizes?
TX, T0, & T4
NX
nearby nodes can’t be tested/evaluated
N0
lymph nodes are cancer free
N1
cancer cells have reached one node
N2
cancer spread to more than one node
N3
cancer in lymph nodes extensive/widespread
M1
Cancer has spread to one or more distant part of the body
still in the original tissue layer
in situ
still in the original organ
localized
spread to nearby lymph nodes or organs
regional
spread to distant body parts
distant
what is the difference between in situ and localized?
in situ is only in one layer of the organ and localized is it is contained in one organ but in different layers
what are tumor markers used for?
monitor to see if body is responding to treatment
what are the different treatments for cancer?
surgery
radiation
chemotherapy
how long should pt wait for chemo if pt has had surgery? viseversa
4 weeks
what does chemotherapy do?
delay healing
most frequent treatment method
surgery
what can surgery be used in conjunction with chemo or radiation for?
prevent
diagnose
stage
treat
what are the types of surgery?
diagnostic
primary
prophylactic
palliative
reconstructive
shave off with blade
send off to lab
no sutures needed
shave biopsy
cylindrical blade goes deep into the different sub q layered tissue
closed with sutures
punch biopsy
affected tumor is large to remove so they do an incision
close with sutures, portion of the tumor is removed
incisional biopsy
30G needle aspirates tissue affected area, usually painless
fine needle
12G needle aspirates more tissue; very painful
core needle biopsy
remove as much of tumor as possible
debulking
can be disfiguring and alter function
radical excision
extensive surgery to site at which previous therapies have failed
salvage surgery
removal of non-vital tissue/organs that may develop cancer
prophylactic surgery
what are the considerations of prophylactic surgery?
-family hx and genetic predisposition
-presence or absence of symptoms
-risks vs benefirs
-ability to detect cancers early
-patients acceptance of post-op outcome
-no pain
-not intended to cure
-goal is high quality of life
-to alleviate disease without curing
palliative surgery
trying to repair injury or loss of function from curative or radical surgeries
-plastic surgery
-may take several procedures
reconstructive surgery
what should nurse do with surgical patient?
-incision care
-prevent infection
-manage pain
-educate on drains, infections, dietary intake to promote healing
what should surgical patients diet contain to promote healing?
protein and vitamin c
eliminate cancerous cells
-affects rapidly proliferating cells
radiation and chemotherapy
-uses energy to kill cells or shrink cells
-damage cell’s DNA
-damage healthy cell’s along the way
-treatment of choice for localized cancer
radiation therapy
how long is radiation given for?
over weeks
why is radiation given over weeks?
allows periphery of tumor to re-oxygenate and become more susceptible to radiation
dependent on presence of oxygen
radiosensitivity of the tumor
point at which normal tissues are irreparably damaged
normal tissue tolerance
total prescribed dose usually divided into several smaller doses
Treatments are usually given daily, 5 days per week for an average of 25 to 30 treatments
volume of tissue to be irradiated
what are the benefits of radiation therpay?
-used before surgery to shrink the tumor
-intra-operative radiation
-given before, during or after chemo
-palliative
-localized to area of treatment
-may be higher if in conjunction with chemo
radiation toxicity
what is the generalized effects of radiation toxicity
fatigue
anemia
N&V
thrombocytopenia
what is another name for external radiation?
teletherapy
what is another word for internal radiation?
brachytherapy
what is a good thing about brachytherapy?
it bypasses a lot of healthy tissue and saves it
-body usually does not give off radiation by pregnant women and small children should avoid exposure to patient
sealed implants
-body will give off radiation
-body secretions may be contaminated
-isolation
unsealed implants
what are some patient teachings for temporary brachytherapy?
-avoid close contact with others until treatment is completed
-no contact with pregnant women
-bed rest to prevent dislodging radioactive souce
-maintain balanced diet, consider small frequent meals
-maintain fluid intake to ensure adequate hydration 2-3 liters/day
what are the side effects of brachytherapy?
-fatigue
-anorexia
-immunosuppression
what are the side effects of radiation?
-fatigue
-skin changes
-alopecia
-immunosuppression
-radiation pneumonia
-ulceration of oral membranes
-GI: N/V/D
what are some patient education for radiation therapy?
-wash treated area only with tepid water and soft wash cloth
-no application of heat or cold packs
-use electric razor ONLY
-do not use any products to the sites during treatment
-do not remove treatment makings on skin
-avoid wearing tight-fitting, startched, or stiff clothing over treatment area
patient education for radiation
do not use: adhesive tape; use paper tape =apply outside of treatment area
protect: protect skin from sun exposure
get: get proper diet, fluid intake for health and repair normal tissue
EAT 5-6 small meals a day fat/fiber/lactose
BRAT for diarrhea
protect: if hair loss occurs, protect head
use of anti cancer drugs to eliminate cancer cells
affects the entire body
death may occur due to side effects
chemotherapy
what is the goal of chemotherapy?
kill cancerous cell while preserving other, more health cells
daily, weekly, monthly
administered in cycles
pill, injection, IV, topical, directly into body cavity
forms of administration
body surface area
dosage carefully calculated
who long can chemotherapy be excreted into the body?
up to 48 hours after treatment
what lab values are you monitoring closely before administering chemotherapy?
WBC
RBC
H&H
can any nurse give chemotherapy?
no, only chemo certified RN
before administering the chemotherapy drug what should you do first?
check the port for blood return
what can happen if you administer the chemotherapy without checking the blood return of the port?
extravasation
what should be taught to a patient receiving chemotherapy?
- hand washing
-48-72 hours after chemo pt should flush toilet twice
-rinse toilet with bleach once a day
-caregiver should wear gloves if in contact with bodily fluids/contaminated laundry
-avoid sexual activity/use 2 forms of birth control
what are the PPE when administering chemotherapy to a patient?
gowns and gloves
what are the routes of exposure of chemotherapy?
inhalation
absorption
ingestion
what are the side effects of chemotherapy?
N/V
alopecia
stomatitis
pain
enteritis
diarrhea
anemia
fatigue
myelosuppression
pancytopenia
neutropenia
thromobocytopenia
granulocytopenia
what is stomatitis?
ulcers in the mouth
N/V that occurs within 24 hours of chemo
acute
N/V that occurs within 2-5 days of chemo
delayed
N/V that occurs before chemo
anticipatory
premedicate pt 15-30 min before treatment
-keep medicating around the clock
ondansetron
extreme muscle wasting
loss of all muscle and fat
unexplained rapid weight loss
anoerxia cachexia syndrome
decreased ability to fight for infection
immunosuppression
risk for infection increases when decreased?
WBC
Neutrophils
risk for anemia increases when decreased?
RBC
H&H
risk for bleeding increases when decreased
platelets
what happens when bone marrow becomes suppressed?
anemia
infection
blood loss
what is NADIR used for?
lowest point of blood cells
occurs at different times
WBC and platelets day 7-14
RBC’s may take several weeks
immune system compromised
treatment designed around Nadir
Absolute Neutrophil Count
>1500
no increased risk for infection
Absolute Neutrophil Count
>10
extremely high risk
what are signs and symptoms of neutropenia?
-fever of 100.5 or higher
-fatigue, body aches
-chills, sweating
-hypotension
-tachycardia
what are symptoms of sepsis?
tachycardia
low bp
high respirations
what is neutropenia?
-abnormally low ANC
-no symptoms until onset of infection
what are some neutropenic precautions?
-wash hands frequently
-low bacteria diet
-no fresh flowers, plants, pets
-avoid large crowds
-no visitors with infections
-no immunization
what is thrombocytepenia
decrease platelets that promote coagulation
what is the reference value of thrombocytes?
150,000-400,000
what is the critical value of thromocytopenia?
<50,000 or >1 million
where are thrombocytes produced?
in the bone marrow 7-9 days
what are some patient education on thrombocytopenia?
-monitor stools/urine for bleeding
-use electric razor only
-apply ice to affected area if trauma occurs
-avoid dental work or other invasive proceudures
-avoid aspirin and aspirn-containing products
-soft toothbrush and no flossing
-no aspirin
what are some nursing management for thrombocytopenia?
-monitor platelet count
-monitor stools and urine for occult blood
-assess skin for ecchymosis, petechiae, and trauma at least every shift
-educate client about bleeding safety precautions
-avoid IM injections and limit venipunctures
what to teach patient about pain measures?
distractions
imagery
relaxation
touch therapy
what are some nursing intervention for patients with chemo brain?
-use calendar or day-planner
-write down everything
-exercise the brain with crossword puzzles or jigsaw puzzles
-get physical exercise as tolerated
-ask for support
what is ascites
patho accumulation of fluid within the abd cavity
what are some nursing mangement of ascites?
-low salt diet
-diuretic therapy
-paracentits
-may place pleurx to enable patient to drain at home
what are the risk factors of breast cancer?
-gender
-increase age 40+
-early menarche/late menopause
-family hx
-high fat diet
-obesity
what are symptoms of breast CA
-painless breast mass
-painful breast mass
-nipple discharge
-local edema
-nipple retraction
-nipple crusting
what are primary preventions for breast CA
-wellness
-smoking cessation
-daily exercise
-health diet
-low saturated fat
-high in fiber
what are secondary preventions og breast CA?
mammogram beginning yearly after 40yrs of age
-SBE
->20 years of age
-perform after menstration
-same time every month
what are tertiary preventions of breast CA?
symptoms control
rehabilitation/reconstruction
what is lymphedema
lifelong accumulation of fluid
what is the assessment of breast exam?
mass felt during BSE
mammogram
a non-moveable mass-typically painless
usually only one breast involved
skin dimpling, puckering
nipple discharge
peau d’orange
late sign: pain, ulceration, cachexia
what are the diagnosis of breast CA?
ultrasound
biopsy
aspiration
incisional
excisional
worse case scenario
not ER or PR reactive
CA does not care about the hormones/hard to treat
triple negative
ER/PR active
easiest to treat
triple positive
what are some treatments for breast CA?
-surgical
lumpectomy
simple masectomy
radical or modified radical masectomy
nonsurgical
-chemo
radiation
hormonal manipulation
radiation
teletherapy
brachytherapy; radium implants, seeds, pellets
what are some preventions for lymphedema?
elevation ROM, ADLs, protect
ABCDE METHOD
A
look for asymmetrical in a mole
ABCDE METHOD
B
assess for an irregular border
ABCDE METHOD
C
is the color a mixture of different color or has it recently changes
ABCDE METHOD
D
is the diameter >6mm
ABCDE METHOD
E
has there been an evolution in the mole size, shape, color
develops from abnormal B cells
rare
5 subtypes
hodgkins
what are symptoms of hodgkins
nigh sweats
itchy skin
itchy head
wt loss
fatigue
develops from abnormal B or T cells
60 subtypes
low cure rate
non hodgkins
is reed-sternberg cell in hodgkins or non-hodgkin?
hodgkins
antibiotics
s/e: nausea and headache
-most effective against H.pylori
-avoid alcohol
-should not be taken during pregnancy
-when treating h.pylori more than one antibiotic should be used
metronidazole
H2 blocker
suppress secretion of gastric acid
contraindicated for people with renal impairment
ranitidine
PPI
-suppress secretion of gastric acid
most effective
s/e: diarrhea and headaches
tablets cannot be crushed
pantoprazole
antiulcer drug
-creates a protective barrier against acid
-administer 1 hour before meals or at bedtime
sucralfate
antacids
neutralizes stomach acid
s/e: constipation
take with a full glass of water
aluminum hydroxide
antiemetic
prevents n/v
s/e: headache diarrhea
-should not be given to pt with long QT syndrome (arrythmeias)
ondansetron
antiemetic
-decrease vomiting
s/e: involuntary repetitive body movement, include grimace, sticking out tongue or lip smaking
a/e: respiratory depression
promethazine
prokinetic
increase upper GI motility and suppressess emesis
s/e: long term high therpay tardive dyskinesia repetitive involuntary movemnt
-moves food along
metoclopramide
bulk forming laxative
acts fiber in the bowel, increases bulk of fecal volume therefore stimulates peristalis
-work 1-3 days
-full glass of water
psyllium
stool softner
docusate sodium
-stimulant laxative
- increase the number of water/electrolytes within the intestinal lumen
-body will become addicted
-acts within 6-12hrs after taking
bisacodyl
antidiarrheal
decrease intestinal motility
diphenoxylate (lomotil)
loperamide (imodium)
what is the bile that is in the liver called?
bilirubin
what does the liver convert that will be excreted via urine?
ammonia
what does bile help absorb?
vitamins
what does the gallbladder store from the liver?
bile
what does the stomach have that helps with processing food into chyme?
gastric glands
what does the stomach have that helps it breakdown?
gastric acids
helps with digestion of food and regulated BS
-bicarbs
pancreas
dehydrates whats left of the food and forms it into stool. it also absorbs water and electrolytes during this process
large intestine-colon
joins into the large bowel. the appendix is attached on the outside of the cecum
the small bowel
most of the absorption of nutrients from food takes place
small intestine
what are the causes of constipation?
opiods
no fiber intake
decrease fluids
sedentary lifestyle
no exercise
what are interventions for constipation?
increase exercise
increase fluid intake
increase fiber intake
what medications can you take for constipation?
stool softner
miralax
psyllium
metoclopramide
what is IBS?
constipation or diarrhea
what is a intervention for IBS?
food diary
whats considered diarrhea?
3+ loose stools a day
what are some questions you can ask patient with diarrhea?
how long have you had diarrhea?
have you traveled?
where did you eat?
any one at home sick?
what are some causes of diarrhea?
viruses
bacteria
c-diff
what are some nursing assessments for a pt with diarrhea?
modifying skin
underlying history
IV fluids
stool cultures
lab and check electrolytes
what are c-diff precautions?
gowns
gloves
must use soap and water
what are the risk factors for peptic ulcers?
h.pylori
long term use of NSAIDS
physical stress
what are some interventions for peptic ulcers?
NG tube/suction
IV fluids
NPO
Pain meds
Labs H&H
VS
what medication should pt take if they have peptic ulcers?
PPI (pantoprazole)
H2 Blocker (rantidine)
anticulcer(sulfacate)
what is a EDG
endoscopy that looks at the
esophageal
gastric
duodenal mucosa
what are complications of peptic ulcers?
hemmorage
perforation
gastric outlet obstruction
can turn into shock
check H&H
hypotension
tachycardia
respiratory distress
vomit blood
hemmorage
septic shock
increase WBC
perforation
swelling, food gets stuck
gastric outlet obstruction
burning sensation between meals/nights, pain stops if you eat or take antacids, pain comes and goes, bloating
peptic ulcer disease
what can cause dysphagia?
parkinsons
brain injury
alzheimers
stroke
what are some interventions for people with dysphagia?
thick food
slow
sit up
speech therapist- swallow study
acid that travels back to the esophagus
GERD
halitosis, belch, a feeling that food is stuck. Peristalis of 2/3 of the esophagus is absent due to neuro response
achalasis
what are some symptoms of alchalais?
felling stuck
nasty breath
what is the treatment for alchalasis?
injecting botox
calcium channel blocker
chronic/acute inflammation of gallbladder
cholecystitis
what are the risk factor for cholecystitis?
more common in women 40+
postmenopausal
sedentary lifestyle
obesity
family tendency
visualize common bile duct
ERCP
what are the symptoms of cholecystitis?
pain associated after eating high fat meal, fever, jaundice, pain can be referred to shoulder/scapula and N/V
what are nursing interventions for cholecystitis?
NG tube
IV fluid
NPO
stop high fatty meals
what some lab/diagnostics for cholecystitis?
ultrasonography
liver function test
serum bilirubin
WBC
HIDA scan
what are the risk factors for acute pancreatitis?
gallbladder disease
chronic alcohol abuse
what are the symptoms of acute pancreatitis?
sudden onset pain, fever,
n/v
jaundince
hypotension
what are the labs for acute pancreatitis?
serum amylase (very high)
lipase high
WBC
urinary amylase
what are intervention/teaching for acute pancreatits?
pt needs to recover/rest from alcohol
pt finds support
TPN
IV FLUIDS
NPO
why do pts get pancreatitis?
the enzymes get stuck and start eating the pancreas
what causes chronic pancreatits?
chronic alcohol abuse
what are the meds for acute pancreatits?
pain meds
ondansetron
what is the number one cause for cirrhosis?
fatty liver
what causes hep A?
oral fecal contamination
what interventions for Hep A?
good handwashing
what causes drug induced hepatits?
acetaminophen
what causes hep b?
mom to baby
needle sticks
body fluids
vaginal secretions
what disease stays in the liver dormant for years until you feel sick and get labs and you get the results?
hep c
how do you get hep c?
blood transfusions
sexual activity
needles
what are the labs for liver disease?
ast & alt
pt
ammonia levels
bilirubin
indicator of liver damage
ast & alt
hepatic encephalopathy
ammonia levels
accumulation of serous fluid in peritoneal or abd cavity
ascietes
what are the nursing assessment for ascietes
measure the girth
their will always be damage to your liver
hep c
what are the causes of inflammatory bowel disease?
crohn’s disease
ulcerative colitis
does crohn’s disease have a cure?
no
what are the symptoms of crohns disease?
diarrhea
cramping
pain
malabsorption
wt loss
fever
fatigue
disease can occur between healthy bowel and disease bowel, this is called skip lesions
crohn’s disease
starts in the rectum and moves up the colon
ulcerative colitis
what are the signs and symptoms of ulcerative colitis?
blood diarrhea 10+ a day
cramping
pain
wt loss
fever
fatigue
anemia
anorexia
what labs will you get for ulcerative colitis?
h&h
electrolytes
what is the cure for ulcerative colitis?
total protocolectomy
is crohns and ulcerative colitis autoimmune
yes
what are the risk factor of diverticulitis?
constipation
inactivity
lack of dietary fiber
obesity
smoking
what are the signs and symptoms of diverticulitis?
vomiting
increase pain
increase temp
what meds should you take with diverticulitis?
ondansetron
what are the interventions of diverticulitis?
IV fluid
ng tube
i&o
NPO
infection/inflammation of diverticulum
diverticulitis
things to know about diverticulitis?
pouch is out
sigmoid colon
what is the main cause of intestinal obstruction in the large bowel?
colorectal cancer
what is the main cause of intestinal obstruction in the small bowel?
surgical adhesions
crohns disease
what are the signs and symptoms of intestinal obstruction?
vomiting
cramping
pain
what are the interventions of intestinal obstruction
iv fluids
labs
i&o
ng tube/suction
npo
pain, bleeding, unusual difficulty swallowing rapidly elevated temperature
perforation
what is the route during a colonoscopy
anus
rectum
sigmoid
transverse
ascending colon
what are the nursing interventions for a colonoscopy
bowel prep
left side w legs to chest
